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Postoperative nausea and vomiting (PONV) are still common problems after anesthesia and surgery, with a markedly high incidence following gynecologic laparoscopic surgery. In the absence of prophylactic antiemetics, gynecologic patients undergoing laparoscopic surgery show a frequent incidence (4077%). Since the first laparoscopic cholecystectomy was performed in 1987, it still remains unclear whether laparoscopic surgery itself is really an independent risk factor of PONV. In recent study, Goll and colleagues suggested that compression of the gastrointestinal mucosa by the surgical pneumoperitoneum could induce intestinal ischemia and thus trigger a serotonin release that could lead to PONV. As well as other neurotransmitters such as dopamine, acetylcholine and histamine, serotonin is involved in the process of nausea and vomiting. Though the exact mechanisms that lead to the development of PONV after these operations are still unknown, we assumed that high incidence of PONV in women undergoing laparoscopic surgery may be attributed to the establishment of pneumoperitoneum, which is a crucial element in laparoscopic surgery. To the extent that this speculation is correct, reducing of insufflation pressure during the CO2 pneumoperitoneum presumably may contribute to reduction in the incidence and/or severity of PONV by decreased production of emetogenic substances or other unidentified mechanism. Though 12-15 mmHg insufflation pressure is considered to Background: Postoperative nausea and vomiting (PONV) is distressing complication of anesthesia and surgery, with a relatively high incidence in women undergoing gynecologic laparoscopy. Therefore, this study aimed to investigate occurrence and severity of PONV of low pressure (LP [8 mmHg]) in comparison to standard pressure (SP [13 mmHg]) pneumoperitoneum. Methods: 46 consecutive patients qualified for elective gynecologic laparoscopy were randomly allocated to either SP group (n = 23) or LP group (n = 23). All the patients were separately evaluated at three intervals of 0-2 h, 2-6 h and 6-24 h during the first postoperative 24 hours with regard to emetic symptoms. Additionally, the degree of surgical exposure in LP group was rated in 4-point scale by surgeon. Results: The overall incidence of PONV during the initial 24 postoperative hours did not differ between the groups (65.2% in LP group vs 82.6% in SP group, P = 0.314). There was also no difference between the groups in regard to the incidence and severity of PONV and postoperative nausea, consumption of analgesics and the need for rescue ondansetron at any separate observation periods. However, some degrees of surgical difficulties were rated in 12 patients (52.1%) from LP group. Furthermore, mean estimated blood loss in LP group was significantly increased than in SP group (P < 0.05). Conclusions: We conclude that lowering of the insufflation pressure to 8 mmHg can not reduce the incidence and severity of PONV after gynecologic laparoscopy and even increase the noticeable surgical difficulties and risks in some cases. (Korean J Anesthesiol 2006; 50: S 36∼42)

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Low Pressure (8 mmHg) Pneumoperitoneum does not Reduce the Incidence and Severity of Postoperative Nausea and Vomiting (PONV) following Gynecologic Laparoscopy